J Emerg Med
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Malpractice in emergency medicine is of high concern for medical providers, the fear of which continues to drive decision-making. The body of evidence evaluating risk specific to emergency physicians is disjointed, and thus it remains difficult to derive cohesive themes and strategies for risk minimization. ⋯ There are consistent diagnoses that are associated with increased litigation incidence. A combination of mitigation approaches may assist providers in mitigation of malpractice risk.
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Pathological laughter is defined as uncontrollable and inappropriate laughter unrelated to an emotion or a mood. This symptom can reveal a stroke. ⋯ We described the case of a 57-year-old patient who presented to the emergency department 2 h after a sudden onset of left hemiparesis preceded by pathological laughter. The left motor weakness was very discrete and underestimated because of severe behavioral changes, that is, laughter, joviality, and motor restlessness. Despite abnormal brain imaging results, symptoms were considered as atypical to evoke a stroke. The patient did not receive intravenous thrombolysis. Brain magnetic resonance imaging performed 2 days after admission confirmed the diagnosis of stroke. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians are at the forefront of stroke management. They should be aware that the initial symptom of a stroke can be atypical and lead to misunderstanding the diagnosis. Because the treatment of stroke requires the fastest care, it is important for emergency physicians to know that sudden behavioral troubles and pathological laughter can reveal strokes.
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Rapid tranquilization of agitated patients can prevent injuries and expedite care. Whereas antipsychotics and benzodiazepines are commonly used for this purpose, ketamine has been suggested as an alternative. ⋯ Ketamine provides rapid sedation for undifferentiated agitated patients and is associated with higher intubation rates when used by ground Emergency Medical Services paramedics, compared with ED or air medical transport patients. Other side effects are common but usually self-limiting.
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Observational Study
Analysis of Temporal and Causal Relationship Between Syncope and 30-Day Events in a Cohort of Emergency Department Patients to Identify the True Rate of Short-term Outcomes.
There are a limited number of studies on the short-term prognosis of syncopal patients, and those available are heterogeneous and often have considered events without a clear relationship with the syncopal episode as serious outcomes. ⋯ The incidence of short-term true outcomes of syncope is extremely low. Distinguishing true outcomes from other events has a crucial significance for understanding the real prognostic role of syncope and for planning ED management. Once patients with syncope as a direct consequence of an acute disease needing admission by itself are excluded, most patients with unexplained syncope could be safely discharged after primary evaluation and brief ED monitoring.